Although having a 20 hour day helps, the real secret is that I end each day with an empty inbox. I have no paper in my office. I do not keep files other than those that are required for compliance purposes.

The end result is that for every document I'm asked to read, every report I'm ask to write, and every situation I'm asked to management, I only handle the materials once.

What does this mean?

In a typical week, I'm asked to review 4 or 5 articles for journals. Rather than leaving them to be read at some later time or reading them then deferring the review, I read and review them the day they are assigned. This enables me to read them once and write the review very efficiently since all the facts are fresh in my mind.

I'm asked to review budgets for various grants, state, and local projects multiple times per week. I read the budget, ask questions while the numbers are at my fingertips, and await responses.

In my 1000+ emails each day there are 10-20 that require detailed responses. I leave these to the end of the day when I know I'll have uninterrupted time. I write the responses and send them while all the details of the issues are clear to me.

Paperwork does occasionally find its way to my desk. Since all payroll and all purchasing functions are electronic at BIDMC, the paperwork I have to do is mostly for externally regulatory agencies. I read the paperwork, answer everything, and give it to my assistant to package and mail.

Each day I'm asked to find time for calls, meetings, lectures, travel, and special events. I look at my calendar in real time and respond with availability - making a decision on the spot if I can or cannot participate.

The end result of this approach is that I truly only handle each issue, document, or phone call once. It's processed and it's done without delay or a growing inbox. I work hard not to be the rate limiting step to any process.

Yes, it can be difficult to juggle the Only Handle it Once (OHIO) approach during a day packed with meetings. Given that unplanned work and the management of email has become 50% of our jobs, I try to structure my day with no more than 5 hours of planned meetings, leaving the rest of the time to bring closure to the issues discussed in the meetings and complete the other work that arrives. It's the administrative equivalent of Open Access clinical scheduling.

It's tempting, especially after a long and emotionally tiring day, to break the OHIO principle. However, doing so only removes time from the next day and makes it even more challenging to process the incoming flow of events.

One last caveat. OHIO does not mean compromising quality or thoughtfulness. Simply passing along issues to others without careful consideration does not increase efficiency. I focus on doing it once to the best of my ability. For larger projects, I use my "handle it once" approach to set aside a defined time on the weekend when I can do them in one sitting.

OHIO - give it a try and see if the free time it creates enables you to regain depth and counter the evils of work induced attention deficit disorder.